Healthcare Provider Details

I. General information

NPI: 1659568756
Provider Name (Legal Business Name): EMDEN ROSE GRIFFIN L.AC., LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 NE 4TH ST STE 2
BEND OR
97701-4647
US

IV. Provider business mailing address

911 NE 4TH ST STE 2
BEND OR
97701-4647
US

V. Phone/Fax

Practice location:
  • Phone: 541-350-0723
  • Fax:
Mailing address:
  • Phone: 541-350-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10489
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number164966
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: